<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta http-equiv="Content-Type" content="text/html; charset=utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">

    <script src="../../plugins/jQuery/jquery-2.2.3.min.js"></script>
    <!-- bootstrap -->
    <link rel="stylesheet" href="../../bootstrap/js/bootstrap.js">
    <link rel="stylesheet" href="../../bootstrap/css/bootstrap.css">
    <title>药饵注册</title>
    <style>
        /*web background*/
        .container{
            display:table;
            height:100%;
            width:100%;
        }
    </style>
    <script src="../ui_js/pillregister.js"></script>
</head>
<body>
<div class="container">
    <div class="row" style="padding-top: 20px;margin-top: 20px">
        <div class="col-md-12">
            <div class="box-body">
                <form role="form">
                    <!-- text input -->
                    <div class="form-group  has-success select-5">
                        <style>
                            @media (min-width: 992px){
                                .select-5 .form-control{
                                    width:18%;
                                    margin-left:15px;
                                }
                            }

                        </style>
                        <label style="padding-bottom: 5px">所属区域(*)</label>
                        <div class="row">
                            <select id="select_province" class="form-control col-md-2" style="margin-bottom: 5px">
                                <!--<option value="-1">请选择</option>-->
                                <option value="0" style="color: #00a65a">全国</option>
                                <option value="150000000000">内蒙古自治区</option>
                                <option value="510000000000">四川省</option>
                                <option value="530000000000">云南省</option>
                                <option value="540000000000">西藏自治区</option>
                                <option value="610000000000">陕西省</option>
                                <option value="620000000000">甘肃省</option>
                                <option value="630000000000">青海省</option>
                                <option value="640000000000">宁夏回族自治区</option>
                                <option value="650000000000">新疆维吾尔族自治区</option>
                                <option value="660000000">建设兵团</option>
                            </select>
                            <select id="select_city" class="form-control col-md-2" style="margin-bottom: 5px">
                                <option value="-1">请选择</option>
                            </select>
                            <select id="select_county" class="form-control col-md-2" style="margin-bottom: 5px"><option value="-1">请选择</option></select>
                            <select id="select_village" class="form-control col-md-2" style="margin-bottom: 5px"><option value="-1">请选择</option></select>
                            <select id="select_hamlet" class="form-control col-md-2" style="margin-bottom: 5px"><option value="-1">请选择</option></select>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>

    <div class="row" style="padding-top: 10px">
        <div class="col-md-6">
            <div class="box-body">
                <form role="form">
                    <div class="alert alert-info alert-dismissible" style="padding: 2px">
                        <h5><i class="icon fa fa-info"></i>药饵信息注册</h5>
                    </div>
                    <!-- text input -->
                    <div class="form-group  has-success">
                        <label>药饵编号：</label>
                        <input type="text" class="form-control" placeholder="药饵编号"  id="input_pillcode" />
                    </div>
                    <div class="form-group  has-success">
                        <label>药饵名称：</label>
                        <input type="text" class="form-control" placeholder="药饵名称" id="input_pillname">
                    </div>

                    <div class="form-group  has-success">
                        <label>生产厂家：</label>
                        <input type="text" class="form-control" placeholder="生产厂家" id="input_pillfactory">
                    </div>
                    <div class="form-group  has-success">
                        <label>规格：</label>
                        <input type="text" class="form-control" placeholder="规格" id="select_pillspec">
                    </div>
                    <div class="form-group  has-success">
                        <label>生产批号：</label>
                        <input type="text" class="form-control" placeholder="生产批号" id="input_batchnum">
                    </div>
                </form>
            </div>
        </div>
        <div class="col-md-6">
            <div class="box-body">
                <form role="form">
                    <div class="form-group  has-success">
                        <label>失效日期：</label>
                        <input id="pill_expdate"  class="form-control" type="datetime-local" value="2017-06-30T00:00"/>
                    </div>
                    <div class="form-group  has-success">
                        <label>采购日期：</label>
                        <input id="pill_buydate"  class="form-control" type="datetime-local" value="2017-06-30T00:00"/>
                    </div>
                    <div class="form-group  has-success">
                        <label>采购人姓名：</label>
                        <input type="text" class="form-control" placeholder="采购人姓名" id="input_pillbuyer">
                    </div>
                    <div class="form-group  has-success">
                        <label>采购人电话：</label>
                        <input type="text" class="form-control" placeholder="采购人姓名" id="input_pillbuyertel">
                    </div>
                    <div class="form-group">
                        <div class="col-md-offset-2 col-md-8">
                            <button type="button" id="a_addpill" class="btn btn-info btn-flat">确认药饵信息</button>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>
</body>
</html>